Innermost Healthcare offer a range of services for pregnant women who wish to have individual tests and checks for additional reassurance including those not available from the NHS as well as those who want the whole package of private antenatal care. We also offer private parentcraft classes and a wide range of holistic services such as women’s and obstetric physiotherapy including the Mummy MOT, pregnancy exercise, acupuncture, psychotherapy and counselling and nutritional therapy.

THIRD TRIMESTER (over 26 weeks)

The third trimester runs from 26 weeks to the end of the pregnancy. During this time the baby’s movements are clearly felt by most pregnant women and they should learn to recognise the unique pattern for their baby. If at any time there is a change in the pattern of movements the woman should contact her maternity healthcare provider immediately to be seen that day for a full assessment of her risks for stillbirth, a heart rate tracing for the baby (CTG) and potentially also a Wellbeing Scan.

Pregnancy is usually divided into three Trimesters each lasting about 13 weeks.

Click on our Pregnancy Timeline to see an overview of all the different tests that may be considered during each of these three stages of pregnancy.

Fetal Growth, Measuring the Bump (S-F height)

Traditional antenatal care in the third trimester is based on measuring the bump (symphysis – fundal height) and detects about 30% of babies who are not growing properly. Plotting the growth measurements on a customised chart (GROW) by trained midwives in a highly structured way (GAP Programme) will improve this to about 50%. This will still miss about half of those babies who are growth restricted and also at increased risk of stillbirth.

Wellbeing Scans

Wellbeing scans however will assess not only fetal size but also other aspects of fetal wellbeing such as the amniotic fluid volume and the blood flow through the placenta (umbilical artery doppler). Serial scans also allow the chance to follow the rate of growth (growth velocity) as this is more important than just measuring size alone. A small baby that is growing normally should be healthy whereas a big baby whose growth has slowed may be in difficulties and at risk. Babies who are significantly compromised or at risk of stillbirth may need early delivery.

4D Baby Bonding Scans

Modern ultrasound scanners allow not only conventional 2D black and white images of the baby but also moving 3D images (4D scan) which clearly show the appearance and facial expressions of the baby smiling, sucking, yawning etc whilst still in the womb. These images can be shared with the pregnant woman and her partner and recorded as colour prints and video clips on DVDs and uploaded to IBabyscan, a personal cloud based store which allows easy sharing on social media like Facebook and Twitter. We always undertake a full Wellbeing Scan to ensure the baby is healthy and the option of checking if it is a boy or girl. This service has been free since 2005 to Welsh mums who are carrying a baby with a cleft lip or palate.

In order to have a safe and successful vaginal birth it is important that the baby is head first (cephalic or vertex) and with no signs of compromise (appropriately grown). Measuring the bump misses half of small for dates babies and a third of those that are breech. A wellbeing scan at 36 weeks should identify most small or compromised babies who do not tolerate labour well and all babies that are breech.

If the baby is breech and otherwise healthy this gives the woman an opportunity to have an external cephalic version (ECV) if to turn the baby to head first to allow a safe vaginal delivery. If the baby is compromised, then a caesarean section may be safer.

Group B Strep Screening (Rectovaginal Swabs at 36 weeks)

About 1 in 6 pregnant women carry a bacteria called Group B Streptococcus (GBS) in their bowel and vagina. Whilst this is usually harmless to the pregnancy before birth it can be picked up by the baby after the waters break or during a vaginal birth.

Infection in the newborn can result in death (about 50 babies a year in the UK) or permanent damage from survivors (about 100 babies a year in the UK). Although these outcomes are rare they are devastating for the woman, partner and her family.

In the UK, NICE advise that all pregnant women who are known to be carrying GBS should be offered intravenous antibiotics (eg Penicillin) to reduce the risk of infection in the baby. The do not however recommend screening for it and so most women who carry GBS are unaware of it and the risk it may pose to their baby. Innermost Healthcare supports the work of the Group B Strep Support charity in advising all women planning a vaginal birth to be offered GBS screening and are listed as one of the UKs GBS Screening Provider Clinics.

Click here to read more about screening for Group B Streptococcus (GBS)

Preterm Birth and Cervical Incompetence

Preterm birth is a major cause of death and handicap in newborn babies affecting 6-8% of pregnancies. Some pregnancies are recognised as being at increased risk such as those who have had a previous very preterm birth (<32 weeks gestation), cervical surgery (eg. cervical cone biopsy), suspected cervical incompetence or multiple pregnancies. In many cases there are no warning signs. Cervical Incompetence Scan (16+ weeks). A transvaginal ultrasound scan (Cervical Incompetence Scan) can assess the cervix to identify pregnancies at increased risk of preterm delivery based on: • Length of the cervix (normally >25mm)

• Funneling of the membranes at the internal os.

• Dilatation of the cervix

• Location of a cervical suture (if present)

Fetal Fibronectin Test (22 to 25 weeks): Another useful way to predict preterm birth is based on a vaginal swab test to identify a substance called fetal fibronectin. The results are available in about 20 minutes. A negative result means that there is over a 99% reassurance that the woman would not go into labour in the next two weeks. This is particularly useful for those going on international holidays or whose partners are travelling or away during the pregnancy. A positive result indicates a high risk of early delivery.

An abnormal Cervical Incompetence scan or a positive Fetal Fibronectin Test allows various interventions to be discussed such as a cervical stitch (cervical cerclage), drugs to relax the uterus and steroids to reduce breathing difficulties (Respiratory Distress Syndrome) in the baby if it is born early.

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